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A clinical predictive model of chronic kidney disease in children with posterior urethral valves

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Abstract

Background

Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs.

Methods

In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables.

Results

Mean follow-up time was 83 months (SD, 70 months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10 years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome.

Conclusion

The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.

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Funding

R.H.M. is supported by NIH grants U01 DK-03012 and R24HD050837. E.A.O. is supported by CAPES grant 2746-15-8. This study was partially supported by CNPq (Brazilian National Research Council, Grant 481649/2013-1, Grant 460334/2014-0), FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Grant PPM-00228-15, Grant PPM-00555-15), and the INCT-MM Grant (FAPEMIG: CBBAPQ-00075-09/CNPq 573646/2008-2).

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Authors and Affiliations

  1. Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil

    Mariana A. Vasconcelos, Ana Cristina Simões e Silva, Izabella R. Gomes, Rafaela A. Carvalho, Sergio V. Pinheiro & Eduardo A. Oliveira

  2. Department of Statistics, UFMG, Belo Horizonte, Brazil

    Enrico A. Colosimo

  3. Division of Pediatric Nephrology, Rady Children’s Hospital San Diego, University of California, San Diego, La Jolla, CA, USA

    Peter Yorgin & Robert H. Mak

  4. Visiting Scholar, Division of Pediatric Nephrology, Rady Children’s Hospital San Diego, University of California, San Diego, La Jolla, CA, USA

    Eduardo A. Oliveira

Authors
  1. Mariana A. Vasconcelos
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  2. Ana Cristina Simões e Silva
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  3. Izabella R. Gomes
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  4. Rafaela A. Carvalho
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  6. Enrico A. Colosimo
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  9. Eduardo A. Oliveira
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Corresponding author

Correspondence to Eduardo A. Oliveira.

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The study was approved by the Ethics Committee of UFMG.

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Vasconcelos, M.A., e Silva, A.C.S., Gomes, I.R. et al. A clinical predictive model of chronic kidney disease in children with posterior urethral valves. Pediatr Nephrol 34, 283–294 (2019). https://doi.org/10.1007/s00467-018-4078-0

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